lookie here:

You're Not Pregnant. Why Do You Think You Are?

by

Heather Corinna

You are afraid you might be pregnant. You may even be 110% convinced that you are. But you're not.

You just didn't do or weren't part of any of the things that can cause a pregnancy. Or perhaps you did have a real risk by being part of the things that can actually pose those risks, but you've since had menstrual periods and negative pregnancy tests: you had a possible risk of pregnancy, but you didn't actually become pregnant.

We get at least a few users in our direct services every day convinced they are or will shortly become pregnant when they just can't be, or won't be, or have every evidence a person can possibly have to know that they did not become pregnant. We talk with users in these situations to try and help them get to the bottom of persistent or irrational pregnancy fears and find out what's really up: their fear may not be about a real pregnancy, but persistent pregnancy fears are always about something. We've found some common threads that usually lie beneath, and until or unless someone deals with whatever that real deal is, those fears just tend to hang on as tight as Dorothy in a Kansas tornado.

Let's start with the facts about who can and can't be, and who is and isn't, pregnant.

You're NOT pregnant nor going to become so if you only did, or were part of, one or more of the following things:

Dry humping (rubbing your genitals together where one or more people involved have some kind of clothing on)

Having someone with a penis ejaculate on some part of your body other than your genitals, like your buttocks, back or breasts

Sitting somewhere where someone did or may have ejaculated (vaginas are sure amazing, but they are still subject to the laws of physics)

Living in the same household or being in the same space as someone with a penis and doing things like using their towels, a toilet they also use, touching their laundry, or sleeping somewhere they have slept

Felt strongly afraid about being pregnant, or having "that feeling" you are pregnant

Something sexual -- but not something that can actually cause pregnancy -- your culture. community, religion, family or friends told you that, if you did it, There Would Be Consequences, and consequences, in your mind or theirs = pregnant.

Wishing you were pregnant or strongly wanting to be pregnant

Being a person who, despite doing or experiencing none of the things needed to actually create a pregnancy in reality, will be "that one in a million" who miraculously becomes pregnant. There is no such person: no one is or has ever been that magic, not even you (who I am sure is totally awesome and powerful, but no one has ever been that awesome or powerful)

Having someone tell you they or someone else became pregnant any of these ways so you may, will or have become pregnant these ways yourself.

You aren't pregnant due to experiencing one or more of those things, because none of those things can create a pregnancy.

We cannot become pregnant with only the power of our minds or feelings, through some kind of god (even if you believe a higher power has something to do with pregnancy, actual human beings and our bodies still have to do the stuff than can make one happen), or by kinds of contact or touch that don't present all the specific and needed circumstances and factors which are required to create a pregnancy. Your friend's friend's cousin who said they became pregnant by touching a towel or using nine kinds of birth control perfectly all at once which all failed didn't have something happen to them we just haven't yet studied or documented: they are either being dishonest, believe something that just isn't true or you're hearing a story that lost some important facts about what really happened along the way.

Or maybe you did do, or were part of, one of the things that CAN potentially cause a pregnancy, which are:

DIRECT genital-to-genital contact, where both people are naked with their genitals interlocked or rubbing right against one another

DIRECT contact between the vulva and ejaculate, where someone with a penis ejaculated directly onto the vulva or in very, very close vicinity (like the perineum) or inside the vagina.

BUT.

You have had one or more menstrual periods.

You have taken pregnancy tests properly and they have shown negative results.

A healthcare provider has screened or examined you for pregnancy and told you you are not pregnant.

It has been over 40 weeks and there is no baby nor any of the gazillion indications you'd be having by now that any minute you're going into labor.

You're. Not. Pregnant.

However, even though you're not, you can't stop freaking out, feeling terrified that you are; you can't seem to let that fear of pregnancy go. The facts, and your rational thoughts, just don't seem to land with this, even when you know, in your head, they're true and real.

You can't seem to shake your conviction that every odd feeling in your body -- most of which you have probably experienced before, but not while you're freaking out like this -- is because you're pregnant. That you're some kind of pregnancy miracle or outrageous fluke. Maybe you have a late or missed period, and even though that has happened before (or maybe it hasn't, and even though that's common, you're sure it's about pregnancy this time), you're sure this time it is because you are pregnant. Maybe you spent way, way too much time with the yahoos that post on Yahoo Answers! who post far more fiction or half-arsed anecdote than fact. Maybe you've been watching that hideously misrepresentative "I Didn't Know I was Pregnant!" show. (Hint: because it's called reality TV doesn't mean what you see is any more realistic than any other media. It's not. It's still very intentionally filmed, edited, constructed and hyped just like your average Hollywood RomCom.) Whatever the reason, you just can't seem to shake this.

If things like in the lists above are true for you, being pregnant right now isn't real. That's not what's happening here. But the feelings of fear you're having are real. They are real feelings. They're just not fears or feelings you're having because you are pregnant.

In order to get past those fears, you're going to have to figure out what they're really about, instead of staying stuck on a pregnancy as their cause. Once you figure out what they're really about, you'll need to effectively and directly deal with whatever that is. I'm going to do my best to help you out by listing some common issues I've seen around this, and some things known to work to address those things effectively, so you can stop feeling so scared and panicked, move forward, and start enjoying your life again.

Why might you think you're pregnant when you're not?

You haven't had access to accurate sex information, so don't know what is and isn't a real pregnancy risk, or how pregnancy actually happens and works.

If we don't know how pregnancy really happens, and what the real risks are and aren't, then it's going to be easy to panic everytime we're near the vicinity of the most general thing -- sex -- we understand it to be related to.

Your next steps are: Reread the text above. Look at pieces like this, this or this. Try this one at Planned Parenthood, or this one at Teen Health Source. Check your local library for books like Our Bodies, Ourselves: look up the facts in sound resources. You can talk to an obstetrician/gynecologist and ask them to explain how pregnancy really does and doesn't happen. If you have been given misinformation growing up, or recently, in a way that felt so compelling you believed it, you can take some time to fact-check that with less emotional, more accurate information like I've suggested above. You can also take some time to figure out why you believed misinformation and learn about how to figure out when information is and isn't likely to be credible, like looking into what someone's agenda is who is giving it to you, what their education and other credentials are, and reminding yourself that just because someone says something is true doesn't mean that it is.

You feel guilty, ashamed or scared about some kind of sex you took part in, or being the victim of a sexual abuse or assault.

Guilt and shame are one serious fear-inducing double whammy. And guilt and shame about sex are incredibly common, especially for young people, people who grew up with -- or are still in -- deeply religious cultures or communities, or both. Nearly all of us live in a world that sends very mixed messages about sex and sexuality, one that also manufactures an awful lot of fear and self-loathing in this department. When that's going on, people can become convinced there is a big, terrible price they must pay for having anything to do with sex, even for being a victim of a sexual assault, where they didn't get to make their own sexual choices in the first place.

If and when we have recently been sexually assaulted, becoming convinced of a pregnancy is also something that can happen, especially when shame, self-blame, or the idea we were assaulted as punishment for something that someone or more than one someone violated us because we somehow were deserving of abuse -- and now will be further punished and violated by an unwanted pregnancy.

Your next steps are: Do all you can to remind yourself that while yes, some people think sex or some kinds of mutually consensual sex are not okay, sinful or bad, those are opinions. That is all they are, as well as projections of someone's own unresolved issues and conflicts, and a means to try and control others. The same goes double for victim-blaming with sexual violence. And while we all get to have our own opinions and personal values, most mental health professionals would agree that those kinds of ideas aren't usually healthy. As well, projecting our options or values onto other people, and trying to dictate what other people should do with their sexual lives, or what values they should have isn't respectful, earnestly caring or kind, even if and when someone says they're only looking out for you. We don't look out for other people by making them feel bad about themselves on purpose.

Ditching sexual guilt and shame -- or guilt and shame after abuse or assault -- unfortunately isn't something that happens overnight. It takes work and it takes time, sometimes many years. This is a huge part of what people working as sex therapists will usually do with their patients or clients. It also often takes distance away from those opinions or ideas, a lot of extra self-care, and a focus on what, per our own values and opinions, is self-care and acceptance, or is, instead, a kind of self-harm. If what you believe in per sex and values is hurting you more than helping you, I'd say it's time to reevaluate.

A counselor or therapist is a great first start. If that doesn't appeal or you don't have access to that kind of care, you can start with some reading instead, like with books like this, this, or this. Giving yourself some extra care, kindness and acceptance, however you can, really helps. Checking in with yourself about what you think you want moving forward, and making sure you stick with whatever that is -- like stepping away from sex for now if you don't feel good about it -- is another biggie. Often with creating our sexual lives, we really do learn as we go. Seek out support from family, partners and friends. If your community is super-shamey around sex or your sexual choices, consider changing it or at least adding some supportive community to your social circles. Set boundaries with anyone giving you grief: try to start telling people to back off when they are making you feel bad. Once you start being a stronger advocate for yourself, other people's opinions tend to have less power, and fewer people will tend to keep trying so hard to push them on you.

Above all else, know that it is okay and you are okay, even the you who is a sexual person, even if you or others feel conflicted or confused about that. It is okay to choose to engage in consensual sex that is mutually wanted. If you have recently been assaulted, what anyone did to you was not okay, but that is because they are not okay, something is the serious matter with them, not because something is wrong with you.

You have the idea that sex of some kind, maybe even all kinds, is something that will result in you being punished, and pregnancy is that punishment.

There's a lot to say about the idea that pregnancy or children are "punishments." Children are people, not punishments, and pregnancy is something that happens, that can happen, or people can choose to do, with their bodies when they are capable of becoming or being pregnant. There's a whole lot in history and the current day that presents pregnancy -- or even just having a vagina or a uterus -- as a punishment, but that's more about the realities of sexism and misogyny than it is about the realities of pregnancy. You, as a specific generation, have gotten a LOT of fear-mongering and intentional induction of panic from the world at large when it comes to teen or young pregnancy and when it comes to sex on the whole. Internalizing little to none of that would have been very unlikely.

People engage in sex all the time, including the kinds of sex that can create a pregnancy. They always have. (And that usually includes the people who are the loudest about these kinds of scary messages.) Some people who have sex have become pregnant. Some of those people have become pregnant sometimes, but not every time. Some of those people never become pregnant, even when they never use any kind of birth control whatsoever, and even when they really, really wantd to become pregnant, even though that's more rare than common. So, this idea that pregnancy is a punishment for sex, or something that will absolutely happen to someone because of sex is totally busted if for no other reason that we know that pregnancy is not something everyone is "punished" with for engaging in sex, whether that sex is or isn't within their or someone else's rules of what or when sex is okay. If someone on high thinks it's wrong and everyone needs to be punished, they're clearly being highly selective or are seriously sleeping on the job.

Your next steps are: Recognize that pregnancy can be one outcome of certain kinds of sex, for some people, some of the time. If and when we're engaging in the kinds of sex that can create a pregnancy, in reality, and are doing so without also doing anything, or effective things, to reduce the risk of pregnancy, pregnancy at some point is a likely outcome. But that isn't because, even if this is part of your belief system, g-d decided to punish people. It's because of biology: without sperm and egg cells, and all the other processes of the body that support them meeting and doing their thing to create a pregnancy, pregnancy would not and could not happen.

Figure out how to square your belief system, if it's yours, with reality and science. If they can't fit together, you have to know that while your beliefs may have value to you or others, they really can't dictate realities or create situations like a pregnancy just by you believing them. If this isn't your belief system, find your own, one that really feels right for you and makes sense with reproductive realities. Again, if your belief system or someone else's is causing you more pain than enlightenment or peace, I'd suggest you shop around and pick another one.

You have some kind of anxiety disorder, like OCD.

Right now, it's estimated that around 8-10% of all young people have an anxiety disorder. That's as many people as use smartphones to use the internet; as many people in the world who are left-handed. In other words, anxiety disorders are very common. The median onset age -- when it usually starts -- for OCD is 19. Anxiety disorders aren't just about feeling anxiety or panic. One thing that's common with them is having, and holding onto, irrational fears and very unpleasant thoughts or ideas. When someone starts having those unpleasant or "bad" thoughts, they increase anxiety even more, then create even more unpleasant thoughts, causing a really awful, ever-escalating cycle of your own personal hell. Anxiety disorders can also make those thoughts or ideas feel very real, even when the situations you're stuck on really aren't real, even when the last thing you'd want is for them to be real.

Your next steps are: Anxiety is a health issue that will usually only resolve itself, and stop derailing your head and your life, when addressed by a healthcare provider, just like strep throat is a health issue that will usually only resolve itself, and stop getting worse, when addressed by a healthcare provider. To deal with it, you'll need some kind of treatment, even though every treatment approach isn't the right one for all people. You'll need to go and see a qualified mental healthcare provider or, if you need a referral for that first, or feel more comfortable starting this way, to see a general physician. You'll tell them about these persistent fears, let them make a diagnosis and try what they suggest, giving whatever it is -- medication, a kind of talk therapy, suggestions about what to change in your life so these fears get triggered less or you manage them better, or all of the above -- time to help.

Something else is up with your reproductive system or general health.

Other things besides pregnancy can present symptoms and feelings similar to pregnancy, or the feeling or sureness that one is pregnant. A feeling of abdominal fullness or "fluttering," for example, can be something people who are pregnant experience, but it's also something people with gallbladder disease, PCOS or a plain old case of gas experience. Periods can be missed or skipped for all kinds of reasons: pregnancy is just one of them. Other mental health conditions besides anxiety disorders can play a part in people thinking they are pregnant when they're not. I don't mean to freak you out when you're already freaked, but some people who experience false pregnancy, or pseudocyesis, may even instead have a form of cancer that can present with similar symptoms, like ovarian cancer. Just because what you're experiencing or feeling are things described as pregnancy symptoms doesn't mean they are, and doesn't mean those physical feelings aren't real: they can be very real, but just be from something else entirely.

Your next steps are: A healthcare provider, where you are going to tell them about this (even if it feels a bit batty to say it out loud), and let them take it from there with you.

You are engaging in sex you really don't feel ready for, or when you just don't have what you need yet in order to feel okay about it.

We can want a thing but not be ready for that thing, or not yet have the right conditions for it to be or feel right for us. Just wanting a thing doesn't make us ready to handle it. Just wanting a thing doesn't magic us the exact right partner, relationship, timing, support or other conditions we need for it to be a good thing, or something that's right for us. But when we're doing something that isn't right for us, or that we don't feel ready for, and one of the things that would make it wrong or be something we couldn't handle is a possible outcome like pregnancy? We can easily lock-on to that consequence, and not see the forest through the trees. It can also be easier sometimes to get stuck on pregnancy as the scary thing than it can to address that sex for us, at a given time, or in a given situation, is the scary thing, especially if the something about saying no or not-now to sex involves conversations we are afraid to have, or other possibilities we want even less, like someone choosing not to keep dating us because they want a sexual relationship we're not ready for.

Your next steps are: Stop having the kinds of sex that are freaking you out. Just for now. It is okay not to be ready for sex, or to have certain conditions we need or want where only with those conditions is it right for us. Being ready for sex doesn't prove or disprove anything universal about us or our maturity, and not having all we need at a given time for sex to be right for us doesn't prove anything other than that we can't always get what we want, something the Rolling Stones already told all of us half a century ago.

Figure out what you need to feel ready and okay, before during and after, and hold those lines for yourself. You can do sexual things, be that masturbation or some kinds of sex with partners, that you DO feel good about, things that don't freak you out like this. But until you really have what you need not to feel so freaked, do yourself a solid and take whatever is making things so scary for you off the table completely. If a partner isn't okay with that, as much as it stinks, it just may be the timing is off for you and them right now: you want different things. No one is wrong in a situation like that, because we get to want different things. Just like other kinds of compatibility in relationships, sometimes what any two people want when it comes to sex just won't mesh, so we have to know that clearly we're just not the right people for each other right now. Partner really not okay with that? Keep reading.

It is scary to be pregnant within an abusive or otherwise unhealthy relationship. It's much harder to leave them when that happens, and when a kid winds up being part of them, in some way you are forever tied to that person through your kid, and your kid winds up with an abuser as a parent. It's also scary all by itself to be in an unhealthy relationship and all that comes with it, which often or eventually includes sexual abuse, assault or sexual coercion. It makes sense to be scared in this kind of relationship or interaction because these are things that can or do deeply harm us, that put or keep us in very real danger, and harm and danger are scary. Reproductive coercion is also a very common part of sexually unhealthy relationships, so maybe that's already happening to you, or you are validly scared that it will. But because you're not pregnant right now, it's not a pregnancy that's making you scared. It's your relationship, and all that could happen to you, within it.

Your next steps are: Recognize and accept -- I know it's hard -- when your relationship isn't a healthy one, and when it is putting you in some kind of harm or danger. When we feel very scared in a relationship, there's usually a good reason for that. Then start taking steps -- I know that can be even harder -- to get out or away, as soon and as safely as you can. Tell someone you know you can trust, who cares about you, who you know or are pretty sure will help you and support you. Seek out help and support from a domestic or interpersonal violence group or shelter if needed. Ask us for help in one of our direct services: this is one of the things we are here and available to help with. Abusive or otherwise unhealthy relationships pretty much never get better, and almost always only get worse. The only way to make things better and safer for yourself, and to stop living in fear, is to get out of them.

Sex hasn't felt or didn't feel as important or big as you wanted it to, or thought it would, so you're trying to add something big to it so it does.

I think it's safe to say that much of the time, most people want sex to be something important, especially when we're young and it's new, and so many sexual experiences are first-times; especially if and when they happen with other feelings and relationships that are first times, like first loves or big losses. If and when we engage in sex we want to be big, important and to have some magnitude and it doesn't, it can feel disappointing, confusing or depressing, and we might try and make it bigger so that it can feel bigger.

Your next steps are: See if you can't figure out why sex isn't feeling like as big of a deal, or as important, as you would like it to or thought it would. Is it about having expectations that aren't realistic? If so, work on adjusting them. Is it about not getting things that are realistic, that you want or need, but aren't happening right now, or with a given person? See if you can't get a handle on what those things are, then make some adjustments, like being clear you want those things, only engaging in sex in certain relationships or contexts that make it big, making sure you're with someone for who it is as big of a deal as it is to you, or by only going into it when it truly feels like something big to you, rather than engaging in sex in ways where you have to act more casual than you feel.

You are unconsciously trying to test your relationship or your partner to see how it, you and a partner would handle a pregnancy crisis.

I'm not saying this is something you're doing on purpose (though people can do it on purpose sometimes). I'm saying you might be holding onto this fear, or even manufacturing it, because it could be a real situation sometime, or with things you have been doing, and you want to see how you or a partner would handle it. Or you want to see how serious your partner is about you, period.

Your next steps are: Ask your partner what they think they might want to do, and how they might handle a pregnancy crisis. Have a talk about it, so you can go ahead and get the information you're seeking. If you are concerned your partner isn't committed enough to you to stick around if you became pregnant, again, ask them. See what they say. If you don't feel like you can trust them to be real in what they are saying, or in general, reconsider the relationship or being sexual with this person.

You want to be pregnant.

When we want something badly, we can convince ourselves it's happening when it isn't. Some people do want to be pregnant very badly. Sometimes people were pregnant, had a pregnancy loss, and still wish they were pregnant or want to be pregnant again. Some people want that when it feels like the right time to be pregnant, and when they very much want to parent. Some people want to be pregnant even if they don't actually want to be parents or give birth: they just want the experience or social status of being pregnant. And sometimes people may want to be pregnant even if something about a pregnancy, or everything about a pregnancy, would be a very negative situation. Sometimes we want weird things, or want even unwanted situations, though that seems like a paradox. Sometimes we just really want care and attention, and we can see that some pregnant people seem to get a lot of it.

Your next steps are: Figure out what you really want. Do you want to be pregnant, are you trying to become pregnant, and you're just aching to be a parent? It can be frustrating when pregnancy doesn't happen as quickly as you want it to, or when the irritations and conflicts of trying to create one are gunking up your relationship, your life, your heart or your head. Seek out support from others in or who have been in the same spot, a partner, family, a counselor or a therapist, especially if you think or know these feelings are due to a pregnancy loss. Do some things in advance you can do before being pregnant that you might be too wiped out to do if and when you are. Take care of yourself: after all, if and when you do become pregnant, there will be a long time where self-care is hard won.

If you know now isn't the right time or situation to become pregnant, or that some part of it -- like a kid you have to parent their whole lives, not just when they're tiny and cute -- really isn't even something you want, but you still want to be pregnant for some reason, think about the things you are hoping it would give you, and see if you can't figure out other ways to get those things. Time spent with kids? Offer to babysit for your friends, mentor and care for kids in your family, look into teaching or daycare as jobs. More attention paid to you? Ask for it from the people you care about: you don't have to be pregnant to get attention. Parents or other people acknowledging you're becoming an adult? Again, you can ask for that, you don't have to be pregnant to get that (and as plenty of teen parents going through pregnancy and parenting with their parents will tell you, often you wind up with adults treating you like more of a child when you get pregnant, not less). Whatever it is you can pinpoint your actual desires as being, focus and go after those in ways that are real and more sound.

You're bored or unstimulated and are manufacturing a crisis or are seeking attention. Maybe you even like feeling afraid.

"Attention-seeking" is something people say young people are doing all of the time, and they usually talk about it like if you're doing it, you lack maturity, or say it like its some kind of sign of your shitty character. It's not. People, all people, need and want attention from others. It's not just a child or teenage thing, it's a people thing. But when you're a teen or a young adult, there is this weird back and forth that can happen where you go from being smothered in attention to only getting it when you mess up in some way, or when something is horribly wrong. Sometimes being given more freedom and room to be on your own can wind up feeling like being abandoned or neglected.

It's okay to want and need attention; it's okay to seek it out when you're not getting what you need. Same goes for wanting stimulus when you feel bored or unstimulated. To want to be deeply engaged in life, to have big things going on, isn't a bad thing or you being a dope. It's wanting to really live a life, one that engages and challenges us.

What if you like how it feels to be afraid? I know that sounds weird. But let's look at some things feeling fear does: it ups our heart rate and quickens our breathing. It floods our body with a bunch of different hormones that give us stimulation and some serious energy. It feels, however awful, exciting in a way. Plenty of people electively choose to do things that scare them because they like being scared sometimes, like riding roller coasters, watching scary movies, or doing things that are risky in some ways, sometimes some big ways. We also get to feel relieved and safe when fear finally goes away or gets resolved.

Your next steps are: Find different ways of creating those feelings and meeting these different needs. If you feel neglected and want some more attention, ask for it from who you'd like it from. If you feel bored, disengaged or understimulated, think about your dreams and passions and invest some real time in things around them, or if you feel aimless, like you don't even know what those are, start trying some new things to find out.

Make sure that you're not putting your whole life and heart into a romantic or sexual relationship, so it's the only place you have to be really engaged. Stand up for someone else who needs someone to do that for them. Ask questions about things others feel passionate about and bounce off that energy. Take positive risks. Wear your heart on your sleeve. Take a road trip. Watch Harold and Maude, if you never have (bias alert: it's my fave film of all time), or just hear something Maude had to say: "A lot of people enjoy being dead. But they are not dead, really. They're just backing away from life. Reach out. Take a chance. Get hurt even. But play as well as you can. Go team, go! Give me an L. Give me an I. Give me a V. Give me an E. L-I-V-E. LIVE!" Explore different, more positive and richer ways to be engaged and excited that maybe feel a little scary, but feel far more positive than hideous, and make you feel motivated, not immobilized; fearless, not fearful.

It can be so hard to let go of our fears sometimes, no matter how miserable and stuck they are making us: fear can be awfully sticky and we can get attached to it. Whatever the reasons we're holding on, while sometimes we can just let fears go, more times than not it takes real time and serious effort to get to what any given fear is all about, work through it, and move on. That's frustrating, and it asks a lot of us. It's hard to go through that process, rather than trying to avoid it or focus on something else, like a pregnancy-that-isn't. Sitting in our discomfort is, obviously, bloody uncomfortable. It's unpleasant. In a word, it freaking sucks. So does looking at real things, sometimes big things, that are hard or shitty or just not something we want to be dealing with or digging into.

But when we get stuck in feeling afraid about something that isn't real, in order to feel differently and move forward, we just have to deal with what is real, and in ways likely to be productive and effective. Whether this is happening around something like misplaced pregnancy fears or something else entirely, it's going to usually happen more than once in our lives. Feeling afraid, or feeling worried about big things we don't want or feel ready to handle, is part of life. We can't usually avoid it completely, but what we can do is learn how to deal when it happens and do our level best to work through it in a way that, when we come out on the other side, will leave us feeling a lot better and a lot more equippped to handle it the next time fear comes creeping by.

the abouts:

Information on this site is provided for educational purposes. It is not meant to and cannot substitute for advice or care provided by an in-person medical professional. The information contained herein is not meant to be used to diagnose or treat a health problem or disease, or for prescribing any medication. You should always consult your own healthcare provider if you have a health problem or medical condition.